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SAINT VINCENT Six Key Functions of the Quality Enterprise 1.Set National Priorities 2.Endorse and Maintain National Standards 3.Develop Measures to Fill Gap in Priority areas 4.Effective Consultative Processes So Stakeholders Can Inform Policies on Use of Measures 5.Collect, analyze and make performance information available and abundant 6.Supporting a sustainable information structure for quality improvement “STAND FOR QUALITY in Health Care”,

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Effective Care: “Proven effectiveness, no significant trade-offs” Beta blocker use among patients post heart attack varies from 5% - 92%, when it should be ~100% Preference-Sensitive Care: “Involves trade-offs, (at least) two valid alternative treatments are available” In Southern California, a patient is 6 times more likely to have back surgery for a herniated disk than in New York City Supply Sensitive Care: “If they build it you will come” Per-capita spending per Medicare enrollee in Miami, FL is almost 2.5 times as great as in Minneapolis, MN Unwarranted Variations: cannot be explained on the basis of illness, scientific evidence or well-informed patient preferences

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SAINT VINCENT Provider risk: is there evidence that it influence behavior?

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Net Impact of Path Recommendations on National Health Expenditures Compared with Current Projection, (in billions) Data: Estimates by The Lewin Group for the Commonwealth Fund Source: The Lewin Group, The Path to a High Performance U.S. Health System: Technical Documentation (Washington, D.C.: The Lewin Group, 2009)

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SAINT VINCENT Pitfalls General -Failure of incentive programs generally not due to the program but to the inadequacy of the psychological assumptions -Rewards typically secure temporary compliance; when the rewards run out people revert

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National Health Care Priority Areas Identified By The National Priorities Partnership Priority AreaGoal Patient and Family Engagement Engage patients and their families in managing their health and making decisions about their care Population HealthImprove the health of the population SafetyImprove the safety and reliability of America’s health care system Palliative CareGuarantee appropriate and compassionate care for patients with life-limiting illnesses Care CoordinationEnsure that patients receive well-coordinated care across all health care organizations, settings, and levels of care OveruseEliminate overuse while ensuring the delivery of appropriate care National Quality Forum, “NGF National Priorities Partnership: Priorities and Goals,” July 2008, (accessed 22 August 2008).

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SAINT VINCENT Promote Quality Improvement A well-designed public reporting program should be aimed at raising the performance of all providers and thereby increase access to high-quality cardiovascular care for everyone.

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SAINT VINCENT Goals of CVRP Establish relevant goals and targets for cardiovascular specialists and their practices to achieve Provide a road map to guide performance improvement and practice transformation strategies Bring consistency to market by standardizing the methodology for how cardiovascular practices are assessed and recognized

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SAINT VINCENT “ Many of life’s failures are people who did not realize how close they were to success when they gave up” Thomas A. Edison